ABSTRACT
BACKGROUND: The vascular closure staple (VCS) clip applier system is an alternative to suture for closing arteriotomies and performing vascular anastomoses. This study was designed to evaluate the possible advantages of its use in closing arteriotomies after embolectomy. METHODS: In this study, 26 patients with upper or lower extremity embolism underwent embolectomy, and the arteriotomy was closed using either VCS clips (group A) or sutures (group B). RESULTS: The time required for arteriotomy closure with clips (11.2 +/- 2.7s) was considerably shorter than the time required with sutures (241.2 +/- 48.7s; p < 0.0001), resulting also in shorter clamp times (380.8 +/- 127.3s vs 612.7 +/- 112.6 s; p < 0.0001). No hemodynamically significant stenoses or pseudoaneurysms were detected at the arteriotomy sites in any of the patients up to 1 year after embolectomy. CONCLUSIONS: The VCS clip applier system, a quick and easy method for closing arteriotomies, is as safe as sutures in terms of narrowing of the artery and formation of pseudoaneurysm.
Subject(s)
Anastomosis, Surgical/methods , Arteries/surgery , Embolectomy/methods , Embolism/surgery , Surgical Instruments/statistics & numerical data , Sutures/statistics & numerical data , Aged , Extremities/blood supply , Humans , Male , Middle Aged , Surgical Staplers , Suture Techniques , Titanium , Treatment Outcome , Vascular Surgical Procedures/methodsABSTRACT
Peripheral arterial embolism arising from a malignant tumour is an infrequent manifestation of neoplastic disease and also a rare cause of acute arterial occlusion. A case of recurrent arterial embolism of the lower extremities due to a primary lung cancer is reported and the literature on this topic is reviewed.
Subject(s)
Embolism/complications , Foot/blood supply , Ischemia/etiology , Lung Neoplasms/complications , Neoplastic Cells, Circulating , Tibial Arteries , Aged , Anticoagulants/therapeutic use , Diagnosis, Differential , Embolectomy , Embolism/diagnosis , Embolism/therapy , Humans , Ischemia/diagnosis , Ischemia/therapy , Lung Neoplasms/diagnosis , Male , Tomography, X-Ray Computed , Ultrasonography, Doppler, DuplexABSTRACT
BACKGROUND: We prospectively examined the ability of dipyridamole thallium scintigraphy (DTS), as a preoperative screening test, to predict postoperative cardiac complications in patients undergoing peripheral arterial operations. METHODS: From November 1993 to November 1995, a DTS study was routinely performed preoperatively in 167 consecutive patients who underwent arterial operations in our hospital. The clinicians were blinded to DTS results. The type of operation was: carotid endarterectomy (n = 53), abdominal aortic aneurysm repair (n = 45), aortobifemoral bypass (n = 31), femoropopliteal bypass (n = 32) and others (n = 6). Clinical and scintigraphic data were collected and analyzed uni- and multivariantly in order to identify those variables that correlate with postoperative cardiac complications. RESULTS: Fifteen adverse cardiac events (three deaths, five myocardial infarctions, seven unstable anginas) occurred postoperatively among 167 patients (mortality: 1.8%, morbidity: 7.2%). Forty-four patients (26.3%) had a normal scintigraphic study, sixty (35.9%) had fixed defects and sixty-three (37.7%) had reversible defects. The most powerful predictive factors of cardiac complications in the multivariate analysis were the synchronous existence of three markers of coronary artery disease (angina pectoris, previous myocardial infarction, Q sign on ECG) and the presence of a reversible defect in the anterior segment of the left ventricle on DTS study. CONCLUSIONS: This study demonstrates that the careful and detailed clinical examination is of paramount importance in detecting "high risk" patients and that DTS should be performed as a supplementary test since it offers significant information and further classifies patients of intermediate risk to develop postoperative cardiac complications.
